title: Increasing rates of breast cancer and cardiac surveillance among high-risk survivors of childhood Hodgkin lymphoma following a mailed, one-page survivorship care plan.
abstract: BACKGROUND
  Hodgkin lymphoma (HL) survivors face substantially elevated risks of breast cancer and cardiovascular disease. They and their physicians are often unaware of these risks and surveillance recommendations.
  
  
  METHODS
  A prospective one-arm study was conducted among a random sample of 72 HL survivors, ages 27-55 years, participating in the Childhood Cancer Survivor Study (CCSS) who were at increased risk for breast cancer and/or cardiomyopathy and had not had a screening mammogram or echocardiogram, respectively, within the prior 2 years. A one-page survivorship care plan with recommendations for surveillance was mailed to participants. In addition, survivors' primary physicians were contacted and provided patient-specific information and a web-based Virtual Information Center was made available for both survivors and physicians. Outcomes were assessed by telephone 6 months after the intervention.
  
  
  RESULTS
  The survivor participation (62/72; 86%) and 6-month retention (56/61; 92%) rates were high. Tension and anxiety, measured by the Profile of Mood States, did not increase following risk notification; 91% of survivors described their reactions to receiving the information in positive terms. At 6 months, 41% of survivors reported having completed the recommended mammogram; 20% reported having an echocardiogram (females 30%, males 10%). Only 29% of survivors visited the website. Nine physicians enrolled, and none used the study resources.
  
  
  CONCLUSIONS
  A mailed, personalized survivorship care plan was effective in communicating risk and increasing compliance with recommended medical surveillance. Internet- and telephone-based strategies to communicate risk were not utilized by survivors or physicians.
authors.affiliation: Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. oeffingk@mskcc.org
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Oeffinger
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Smith
authors.forename: Pauline A
authors.initials: PA
authors.lastname: Mitby
authors.forename: Debra A
authors.initials: DA
authors.lastname: Eshelman-Kent
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Ford
authors.forename: Judith K
authors.initials: JK
authors.lastname: Jones
authors.forename: Sharmila
authors.initials: S
authors.lastname: Kamani
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
mesh_terms: D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000517:prevention & control*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000150:complications*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000517:prevention & control*; D010349:Patient Compliance; D011159:Population Surveillance; D011320:Primary Health Care / Q000458:organization & administration*; D011379:Prognosis; D011446:Prospective Studies; D011787:Quality of Health Care; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult